It is now well recognized that CKD stage 5 patients receiving dialysis may also be at risk of developing chronic inflammation resulting in a more severe syndrome characterized by malnutrition and resistance to exogenous erythropoietin replacement therapy. Markers of a chronic inflammatory state that are observed in dialysis patients include hypoalbuminemia, elevated C-reactive protein (CRP), elevated ferritin, increased serum amyloid A and low transferrin saturation. In addition, pro-inflammatory cytokines such as interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-alpha) and interleukin 1 (IL-1) have been shown in vivo to suppress erythroid colony forming units. Erythrocyte lifespan can also be shortened through increased clearance by macrophages that are activated by inflammatory signals and immunoglobulin coated erythrocytes.